Organization · Type 2 NPI

Wellness Legacy LLC

Psychiatric/Mental Health Nurse Practitioner · Towson, MD

NPI number 1992433916 Active

Practice location

1016 Dulaney Valley Rd
Towson, MD 21204-2702

Call (410) 286-1258 Map

Mailing address

1539 Blakes Legacy Dr
Bel Air, MD 21014-1946

Specialties and licenses

Taxonomy	Code	License
Psychiatric/Mental Health Nurse Practitioner Primary	363LP0808X	None listed

Psychiatric/Mental Health Nurse Practitioner: Definition to come...

Another provider at this address

Anna Cresta Ibanez Decena-Trinidad, PMHNPPsychiatric/Mental Health Nurse Practitioner Towson, MD NPI 1780487504

Other psychiatric/mental health nurse practitioner providers in Towson

See all in Towson →

NPI record

NPI: 1992433916
Entity type: Organization (Type 2)
Issued: Aug 9, 2022
Last updated: Mar 27, 2024
Status: Active
Subpart: Yes of Wellness Legacy LLC

Other names

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Wellness Legacy LLC · doing business as

Authorized official

Mark Anthony Bergonia Ison, CRNP- PMH
Co -Owner
(410) 286-1258

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1992433916

Wellness Legacy LLC's National Provider Identifier is 1992433916, issued on Aug 9, 2022. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Towson, MD. The record was last updated on Mar 27, 2024.